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38: Blood and Body Fluid Exposure

Key Points

A blood or body fluid exposure refers to contact with potentially infected fluids through non-intact skin, mucous membranes, or skin penetrated by a sharp object.

Prevention is the cornerstone to reducing infectious exposures.

Administering postexposure prophylaxis for human immunodeficiency virus is a time-sensitive decision, necessitating that the exposed patient visit the emergency department when the employee health office is closed.

Hepatitis B vaccination greatly reduces the seroconversion rate when a health care worker is exposed to blood and body fluid.

Introduction

The Centers for Disease Control and Prevention define an exposure to blood and body fluids as contact with potentially infectious fluids that put health care workers at risk of infectious disease. This may come from a break in the skin by a sharp object (eg, a needle or scalpel) or contact with mucous membranes or already present breaks in the skin. The infectious diseases for which a health care worker is at risk include human immune deficiency syndrome (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV).

Not surprisingly, most needlestick injuries come from teaching hospitals, usually within operating rooms or the emergency department (ED) where sharp instruments are used routinely. Syringe and suture needles are the most common offending devices. The risk of seroconversion after needlestick exposures varies depending on the pathogen. For hepatitis B, the risk of transmission is up to 30% if the source patient is e-antigen positive. If the source patient is e-antigen negative, the risk drops to 1–6%. The risk of transmission of hepatitis B substantially decreases in those who have received the hepatitis B vaccine. The risk of transmission of hepatitis C is 1.8%, whereas the risk of HIV risk is 0.3%. Postexposure prophylactic medications are administered to decrease the seroconversion rate for HIV and HBV.

Blood or any specimen visibly contaminated with blood is the most common vector for transmission; however, other potentially infectious fluids include semen, vaginal secretions, and cerebrospinal, synovial, pleural, peritoneal, pericardial, and amniotic fluids. The risk of transmission of disease in these fluids is unknown. Fluids that are not considered infectious include feces, nasal secretions, saliva, sputum, sweat, tears, urine, and vomitus, unless of course they contain blood.

The best defense against a blood and body fluid exposure is prevention. Standard precautions should be used when caring for all patients. Standard precautions include proper hand washing; the use of gloves, masks, and gowns; and proper disposal of medical waste and safe needle usage. Health care workers should wash hands before and after contact with every patient, even if gloves were worn. The use of soap and water (or an alcohol-based gel or foam) is the most important factor in decreasing the transmission of disease.